Hamstrings tendons need to be combined and folded to make the autograft construct.
From where is the autograft taken?
Autograft can be harvested from the patient's own hamstrings tendons, the patellar tendon, the quads tendon or in some cases also the iliotibial band.
Surgeons probably have the most experience with harvesting the graft from the patellar tendon.
Peer-reviewed papersQuote from peer-reviewed paper:
"....there is no consensus to what the best graft option is to replace the injured ACL....[but the] decision must be made prior to surgery regarding the type of graft that will be used...."
Citation: Macaulay AA, Perfetti DC, Levine WN. Anterior cruciate ligament graft choices. Sports Health. 2012 Jan;4(1):63-8. doi: 10.1177/1941738111409890. PMID: 23016071; PMCID: PMC3435898.
The biological advantages of autograft
Although harvesting autograft material from the patient leaves them with a harvest site that may be a bit compromising, autograft has the advantages of being genetically identical to the tissue it is replacing.
Also it is not treated with any chemicals or physical processes and it is warm and fresh. The new ligament construct will still need, however, to re-establish a blood supply and re-fashion itself to fit its new purpose.
Peer-reviewed papersQuote from peer-reviewed paper:
"....Semitendinosus and gracilis tendons (quadrupled hamstring tendon....minimize donor site morbidity....[and] theoretically cause less anterior knee pain...."
Citation: Macaulay AA, Perfetti DC, Levine WN. Anterior cruciate ligament graft choices. Sports Health. 2012 Jan;4(1):63-8. doi: 10.1177/1941738111409890. PMID: 23016071; PMCID: PMC3435898.
Quote from peer-reviewed paper:
"....bone–patellar tendon–bone (BPTB) allows for bone-to-bone healing within the tibial and femoral tunnels and has theoretical advantages of faster healing...."
Citation: Macaulay AA, Perfetti DC, Levine WN. Anterior cruciate ligament graft choices. Sports Health. 2012 Jan;4(1):63-8. doi: 10.1177/1941738111409890. PMID: 23016071; PMCID: PMC3435898.
Quote from peer-reviewed paper:
"....A third option is the quadriceps tendon (QT), which can include a bone block from the patella (BQT)."
Citation: Macaulay AA, Perfetti DC, Levine WN. Anterior cruciate ligament graft choices. Sports Health. 2012 Jan;4(1):63-8. doi: 10.1177/1941738111409890. PMID: 23016071; PMCID: PMC3435898.
Forum discussions
- My experience so far
PE teacher (plus martial arts) discussing hamstring autograft, through early post-op and physio and finally back to sports.
- All the exercises I have ever done throughout ACLr
A patient's very detailed list of the rehab regime after ACL reconstruction. Useful to print and refer to as you progress through your rehabilitation.
- The whole cruciate ligament Board on the forum
Dozens and dozens of cruciate ligament discussions.